Professor Mark Freeston
Making and keeping friends with uncertainty: What have we learned about understanding and managing uncertainty distress during the pandemic?
On Demand CBT workshop
University of Newcastle, UK
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Making and staying Friends with Uncertainty
While we have known about the role of threat in anxiety for many years, the role of uncertainty has only gradually emerged as an equally important contributor. Although anxiety and worry are important and frequent, people also respond to uncertainty with frustration, anger, guilt, as well as loss and anticipated loss and sadness.
Bringing together three established models, this CBT workshop will provide a framework to think about the contributions of threat and uncertainty to distress. First, the classic cognitive model of anxiety helps us understand the roles of actual threat and overestimation of threat. Second, the model of perceived uncertainty developed in the context of long-term illness helps understand how actual uncertainty can become inflated through various perceptual processes and behaviours. Third, current models of intolerance of uncertainty help us understand how disruption due to changes in peoples’ lives leads to increased perceptions of both threat and uncertainty. While the dominant point of reference has been the pandemic, the model is also relevant to any situation with elements of threat and uncertainty, including serious illness, caregiving in conditions like dementia, vaccines, long covid and climate change. While the sources of threat and uncertainty will differ in content, the processes will remain the same. So, uncertainty can be experienced both individually and collectively, and the model can help us understand both.
The earlier part of the workshop will cover the interventions from our workshops in the first nine months of the pandemic that can help reduce the distress by decreasing perceptions of threat and especially uncertainty. Early interventions include managing information and building safety to counter the disruption and information overload associated with the pandemic. Then some of the classic anxiety interventions can be used to target overestimation of threat, although in real-world situations the distress may be proportionate rather than excessive as in clinical anxiety. Finally, interventions recently developed for intolerance of uncertainty in anxiety disorders can help produce greater resilience.
The latter part of the workshop will address some newer ideas we have been considering more and more through 2021 and which we think will still be relevant in 2022 and beyond. Although the pandemic will have moved on and the disruption will probably be less, we will still be dealing with disrupted timelines and a growing realization that although life may be more like it was before, life remains fundamentally uncertain. Helping people re-establish timelines from past, to present, to future and engaging in goal directed behaviour in the face of ongoing uncertainty will be important therapeutic tasks. Likewise, we are understanding more and more how organizations, systems and teams contribute to both increasing and decreasing uncertainty by the way they behave and communicate. Finally, for those who willingly or unwillingly have made friends with uncertainty during the pandemic, helping them stay friends with uncertainty as they move forward will be an important therapeutic task in many situations.
Follow our work on uncertainty distress (articles, blog, resources, clinical materials, etc.) at covid19an.com
References (click the link)
Mofrad, L., Tiplady, A., Payne, D., & Freeston, M. (2020). Making friends with uncertainty: Experiences of developing a transdiagnostic group intervention targeting intolerance of uncertainty in IAPT. Feasibility, acceptability and implications. The Cognitive Behaviour Therapist, 13, E49. doi:10.1017/S1754470X20000495
Professor Mark Freeston
University of Newcastle
My training and the first part of my career as a clinical researcher was at Université Laval (Québec) until 1997 and then at Université de Montréal in Canada. In 2000 I moved to Newcastle-upon-Tyne (UK) and I have been research director for the Doctorate in Clinical Psychology since 2001. From 2000 until 2018 I also held a research, training and development role at the Newcastle Cognitive and Behavioural Therapies Centre, a regional specialist mental health service within the NHS.
My main research interests have been in the field of Obsessive Compulsive Disorder and Generalized Anxiety Disorder and other disorders dominated by intrusive thoughts, worry and rumination. The focus is to extend psychological models of these and other disorders through increasing the degree of specification. Through this strategy I believe we will ultimately develop a knowledge base that will enable treatments to become more effective for those who currently benefit little with existing psychological treatments.
I have been investigating the role of Intolerance of Uncertainty along with colleagues and students at Newcastle for over a decade. We first became interested in Intolerance of Uncertainty (IU) in 1993 at Université Laval (Quebec) when we realized that for people with Generalized Anxiety Disorder, uncertainty was part of the threat or threatening in and of itself. From a hunch came a questionnaire published in 1994, the Laval model of GAD with IU at its heart, then a treatment with several RCTs, and much more work on the model. It appears to have face validity, resonates as a concept with clinicians and patients alike and it is being used with different populations and in different areas of psychological research. Along with a range of collaborators, our current lines of research in this area include the nature of IU and its manifestations in everyday life; its possible origins and developmental course, its potential contribution to anxiety (including performance anxiety), depression, psychosis, and autism spectrum disorders; its possible role in physical health conditions, its presentation in non-western cultures, IU and healthy ageing, developing IU-specific treatment strategies, how people use internal body signals in response to uncertainty, etc.
In the last three years we have been looking at IU as a trans-situational factor and how people react to real life events that occur and have both uncertainty and threat as their defining features. Since the pandemic we have been developing and testing the model, developing interventions, and providing training for uncertainty distress. Ongoing tests of the model include the various uncertainties of the pandemic that also go beyond the virus (finances, occupation, social change, etc.), Long Covid, vaccines, climate change and extreme weather, and long-term health conditions, carers of people with dementia, and clinical training.